GPhC Registration Assessment — Questions and Answers

Question 1: Which concentration unit is used for very dilute solutions in pharmacy?

Molarity
Percentage w/v
Parts per million (ppm) (Correct answer)
Osmolarity

Correct answer: Parts per million (ppm)

Parts per million (ppm) is used for very dilute solutions, equivalent to 1 mg per litre (1 mg/L) or 1 µg/mL for aqueous solutions.

Question 2: According to BNF, which medication should be avoided in patients with eGFR <30 mL/min/1.73m²?

Amlodipine
Omeprazole
Atorvastatin
Metformin (Correct answer)

Correct answer: Metformin

Metformin is contraindicated when eGFR <30 due to the risk of lactic acidosis from drug accumulation in renal impairment.

Question 3: What must a pharmacist do if they have a conscientious objection to dispensing a legal prescription?

Contact the prescriber to cancel the prescription
Refuse without providing any alternative
Refer the patient to another provider who can dispense it (Correct answer)
Dispense it regardless of personal beliefs

Correct answer: Refer the patient to another provider who can dispense it

GPhC standards require that even if a pharmacist exercises a conscientious objection, they must ensure the patient receives the care they need by referring them to another provider promptly.

Question 4: What is the recommended action if a patient on an ACE inhibitor develops a persistent dry cough?

Switch to an angiotensin receptor blocker (ARB) (Correct answer)
Switch to a beta-blocker
Add an antihistamine
Increase the ACE inhibitor dose

Correct answer: Switch to an angiotensin receptor blocker (ARB)

ACE inhibitor-induced cough is caused by bradykinin accumulation. Switching to an ARB (which does not affect bradykinin) resolves the cough while maintaining cardioprotective benefit.

Question 5: A patient on atorvastatin develops severe muscle pain and dark urine. What is the most likely diagnosis?

Deep vein thrombosis
Acute hepatitis
Peripheral neuropathy
Rhabdomyolysis (Correct answer)

Correct answer: Rhabdomyolysis

Severe myopathy progressing to rhabdomyolysis is a rare but serious statin side effect. Dark urine (myoglobinuria) with muscle pain should prompt urgent CK measurement and statin cessation.

Question 6: What does 'Monitored Dosage System' (MDS) refer to in pharmacy dispensing?

A compliance aid where medicines are pre-packaged in individual compartments by day and time (Correct answer)
An electronic prescription system
A system for ordering medicines from wholesalers
A method for recording controlled drug transactions

Correct answer: A compliance aid where medicines are pre-packaged in individual compartments by day and time

MDS (e.g., Dosette boxes, Nomad trays) organises medicines into daily/weekly compartments to aid patient compliance, typically used for elderly or cognitively impaired patients.

Question 7: Which pharmacist-initiated service involves reviewing all medicines for an older patient with multiple long-term conditions?

Minor Ailments Scheme
New Medicines Service
Flu vaccination service
Medicines Use Review (MUR) / Structured Medication Review (SMR) (Correct answer)

Correct answer: Medicines Use Review (MUR) / Structured Medication Review (SMR)

Structured Medication Reviews (in PCNs) and previously MURs involve pharmacists reviewing the complete medicines regimen of patients on multiple medications to optimise therapy and reduce harm.

Question 8: What is a Patient Group Direction (PGD)?

A prescription written for a group of patients
A written instruction allowing specific healthcare professionals to supply medicines to patients meeting defined criteria without individual prescriptions (Correct answer)
A direction from NHS England about prescribing
A protocol for dispensing repeat prescriptions

Correct answer: A written instruction allowing specific healthcare professionals to supply medicines to patients meeting defined criteria without individual prescriptions

PGDs allow named healthcare professionals to supply or administer specified medicines to patients in defined clinical situations without requiring a prescription for each individual.

Question 9: Which drug used in COPD exacerbations is a short-acting beta-2 agonist?

Tiotropium
Salmeterol
Salbutamol (Correct answer)
Beclometasone

Correct answer: Salbutamol

Salbutamol is a short-acting beta-2 agonist (SABA) used as rescue bronchodilator in COPD and asthma exacerbations due to rapid onset of action.

Question 10: A prescription for a private patient requires a 28-day supply of morphine sulphate modified release 30 mg bd. What is the total quantity?

112 tablets
28 tablets
14 tablets
56 tablets (Correct answer)

Correct answer: 56 tablets

28 days × 2 doses per day = 56 tablets. The prescription must state 'fifty-six (56) tablets' in both words and figures as a Schedule 2 CD requirement.

Question 11: Which vaccine is a live attenuated vaccine and thus contraindicated in immunocompromised patients?

Influenza (injected)
Hepatitis B
MMR (measles, mumps, rubella) (Correct answer)
Pneumococcal conjugate

Correct answer: MMR (measles, mumps, rubella)

MMR is a live attenuated vaccine and is contraindicated in severely immunocompromised individuals as it may cause vaccine-strain disease. Inactivated vaccines are safe to use.

Question 12: According to the Misuse of Drugs Act 1971, Class A drugs include:

Heroin, cocaine, and LSD (Correct answer)
Benzodiazepines only
Anabolic steroids
Cannabis and amphetamines

Correct answer: Heroin, cocaine, and LSD

Class A drugs carry the most severe penalties under the MDA 1971. They include heroin (diamorphine), cocaine, crack cocaine, MDMA (ecstasy), and LSD.

Question 13: A prescription requires 0.5% w/v hydrocortisone cream in 50 g. How many milligrams of hydrocortisone are needed?

250 mg (Correct answer)
500 mg
100 mg
50 mg

Correct answer: 250 mg

0.5% w/w means 0.5 g per 100 g. In 50 g: 0.5 × 50/100 = 0.25 g = 250 mg.

Question 14: During dispensing, a pharmacist notices a prescription for amoxicillin 250mg/5mL suspension with directions 'take 5mL three times a day for 7 days' but the quantity prescribed is only 50mL. What should the pharmacist do?

Dispense 50mL and tell the patient to return for more
Dispense 50mL as written on the prescription
Dispense 100mL as the nearest available pack size
Contact the prescriber to clarify — the dose and duration require 105mL, not 50mL (Correct answer)

Correct answer: Contact the prescriber to clarify — the dose and duration require 105mL, not 50mL

The required quantity is 5mL × 3 times daily × 7 days = 105mL, but only 50mL has been prescribed. This discrepancy between dose/duration and quantity could mean the course will be incomplete. The pharmacist should contact the prescriber to clarify whether the quantity, dose, or duration needs correcting to ensure the patient receives a complete course.

Question 15: Which antibiotic class should be avoided in children under 12 years due to effects on developing joints?

Penicillins
Fluoroquinolones (e.g., ciprofloxacin) (Correct answer)
Cephalosporins
Macrolides

Correct answer: Fluoroquinolones (e.g., ciprofloxacin)

Fluoroquinolones can damage developing cartilage in children and adolescents, causing arthropathy. They are generally avoided in children under 18 unless no safer alternative exists.

Question 16: According to NICE, which antidepressant class should be avoided in patients with a recent MI?

Mirtazapine
SNRIs
SSRIs
Tricyclic antidepressants (TCAs) (Correct answer)

Correct answer: Tricyclic antidepressants (TCAs)

TCAs have cardiotoxic effects including QT prolongation and arrhythmia risk, making them contraindicated post-MI. SSRIs are preferred for depression post-MI.

Question 17: In pharmaceutical compounding, a 'tincture' is defined as:

An alcoholic extract of plant material (Correct answer)
A sterile injectable solution
A water-based suspension
An oil-based cream

Correct answer: An alcoholic extract of plant material

Tinctures are alcoholic or hydroalcoholic extracts prepared from plant materials or animal drugs, typically at a 1:5 or 1:10 ratio.

Question 18: A dispensing error results in a patient receiving the wrong dose. What immediate steps must be taken?

Wait to see if the patient reports symptoms
Only document the error internally
Recall the dispensed medicine, inform the patient and assess for harm, report through incident system, and document (Correct answer)
Inform only the prescriber

Correct answer: Recall the dispensed medicine, inform the patient and assess for harm, report through incident system, and document

Immediate steps include: recalling the incorrect item, contacting and informing the patient, assessing for harm, appropriate clinical management if needed, and internal/external incident reporting.

Question 19: A patient presents with a prescription for co-trimoxazole. They mention they are also taking warfarin. What is the key safety concern?

Warfarin reduces the antibacterial efficacy of co-trimoxazole
There is no clinically significant interaction
Co-trimoxazole enhances the anticoagulant effect of warfarin, increasing bleeding risk (Correct answer)
Co-trimoxazole reduces warfarin absorption

Correct answer: Co-trimoxazole enhances the anticoagulant effect of warfarin, increasing bleeding risk

Co-trimoxazole significantly potentiates the anticoagulant effect of warfarin through multiple mechanisms: the trimethoprim component inhibits CYP2C9 (the main enzyme metabolising S-warfarin), and the sulfamethoxazole component may displace warfarin from protein binding. This can cause dangerously elevated INR and serious bleeding.

Question 20: A mother asks for something to treat her 4-year-old child's fever. Which product is most appropriate?

Codeine-containing liquid
Adult paracetamol 500 mg tablets
Paracetamol suspension (120 mg/5 mL) or ibuprofen suspension (Correct answer)
Adult aspirin tablets

Correct answer: Paracetamol suspension (120 mg/5 mL) or ibuprofen suspension

Paracetamol (120 mg/5 mL) and ibuprofen suspensions are appropriate for children aged ≥3 months. Aspirin is contraindicated under 16 (Reye's syndrome risk). Adult formulations are inappropriate doses.

Question 21: Which factor does NOT affect drug absorption from an oral solid dosage form?

Gastric emptying rate
Dissolution rate
Hair colour of the patient (Correct answer)
Particle size of drug

Correct answer: Hair colour of the patient

Hair colour has no pharmacological relevance. Particle size, dissolution rate, and gastric emptying rate all significantly influence oral drug absorption.

Question 22: Which antibiotic is recommended as first-line treatment for an uncomplicated lower urinary tract infection in a non-pregnant adult woman, according to NICE guidelines?

Amoxicillin 500mg three times daily for 7 days
Nitrofurantoin 100mg modified-release twice daily for 3 days (Correct answer)
Ciprofloxacin 500mg twice daily for 3 days
Co-amoxiclav 625mg three times daily for 5 days

Correct answer: Nitrofurantoin 100mg modified-release twice daily for 3 days

NICE recommends nitrofurantoin 100mg MR twice daily for 3 days (or trimethoprim 200mg twice daily for 3 days if low risk of resistance) as first-line for uncomplicated lower UTI in non-pregnant women. Fluoroquinolones should be reserved for more serious infections due to resistance concerns and side effects.

Question 23: Under GPhC standards, a pharmacist must maintain their competence through:

Continuing professional development (CPD) relevant to their scope of practice (Correct answer)
Attending one training course per decade
Reading pharmacy journals only
Annual GPhC examinations

Correct answer: Continuing professional development (CPD) relevant to their scope of practice

GPhC standards require all pharmacy professionals to maintain and develop their competence through ongoing CPD activities relevant to their current professional role and scope.

Question 24: An insulin pen delivers 100 units/mL. A patient is prescribed 36 units twice daily. How many days will a 3mL cartridge last?

4 days (Correct answer)
2 days
10 days
8 days

Correct answer: 4 days

Total units in cartridge = 100 units/mL × 3mL = 300 units. Daily dose = 36 units × 2 = 72 units/day. Days supply = 300 ÷ 72 = 4.17 days, so the cartridge will last 4 complete days.

Question 25: What is the molecular basis of drug tolerance?

Enhanced gut absorption
Increased renal excretion
Reduced protein binding
Receptor downregulation (Correct answer)

Correct answer: Receptor downregulation

Tolerance often develops due to receptor downregulation — the number or sensitivity of receptors decreases with repeated drug exposure, reducing effect.

Question 26: Which of the following interventions has the strongest evidence base for improving long-term medication adherence?

Issuing all long-term medicines in monitored dosage systems
Simplifying the medication regimen by reducing dose frequency where possible (Correct answer)
Increasing the frequency of prescriber follow-up appointments
Providing written patient information leaflets with every prescription

Correct answer: Simplifying the medication regimen by reducing dose frequency where possible

Simplifying medication regimens — for example by using once-daily formulations or combination products — consistently improves adherence across a wide range of conditions and patient populations.

Question 27: A patient's eGFR drops from 65 to 28 mL/min/1.73m². Which drug adjustment is most urgent?

Only stop diuretics
Stop metformin, reduce renally-cleared drug doses, review nephrotoxic agents (Correct answer)
Increase all drug doses to compensate
No changes needed if patient is asymptomatic

Correct answer: Stop metformin, reduce renally-cleared drug doses, review nephrotoxic agents

An eGFR of 28 indicates moderate-severe CKD (Stage 3b-4). Metformin must stop (risk of lactic acidosis). Many renally-cleared drugs need dose reduction or cessation to prevent accumulation and toxicity.

Question 28: What is the osmolarity of normal saline (0.9% NaCl) approximately?

154 mOsm/L
100 mOsm/L
308 mOsm/L (Correct answer)
500 mOsm/L

Correct answer: 308 mOsm/L

0.9% NaCl dissociates into Na+ and Cl−, each at 154 mmol/L, giving approximately 308 mOsm/L, which is isotonic with blood.

Question 29: What is the first-line treatment for Clostridium difficile infection according to UK guidelines?

Oral ciprofloxacin
Oral vancomycin or fidaxomicin (Correct answer)
Oral amoxicillin
Intravenous metronidazole

Correct answer: Oral vancomycin or fidaxomicin

UK guidelines (PHE/NICE) recommend oral vancomycin or fidaxomicin as first-line treatment for C. difficile infection. Oral metronidazole is no longer first-line.

Question 30: Which OTC antacid ingredient is most likely to cause constipation?

Calcium carbonate
Sodium bicarbonate
Magnesium hydroxide
Aluminium hydroxide (Correct answer)

Correct answer: Aluminium hydroxide

Aluminium-containing antacids cause constipation by reducing GI motility. Magnesium-containing antacids tend to have a laxative effect. Products combining both can balance these effects.

Question 31: What does 'bioavailability' refer to?

The speed at which a drug is metabolised
The volume in which a drug distributes
The fraction of administered drug that reaches systemic circulation (Correct answer)
The rate of renal excretion

Correct answer: The fraction of administered drug that reaches systemic circulation

Bioavailability (F) is the proportion of an administered dose that reaches the systemic circulation unchanged. IV administration gives 100% bioavailability.

Question 32: What is the maximum legal quantity of paracetamol that can be sold in a single transaction in a pharmacy (non-prescription)?

Unlimited
32 tablets
16 tablets
100 tablets (or equivalent) (Correct answer)

Correct answer: 100 tablets (or equivalent)

In a pharmacy (as opposed to non-pharmacy retail), up to 100 paracetamol tablets (500 mg) can be sold in a single transaction, versus 32 in general sales.

Question 33: What is meant by 'medication reconciliation' at hospital discharge?

Only listing all medicines given during admission
Transferring the hospital drug chart to the GP unchanged
Cancelling all hospital medications
Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient (Correct answer)

Correct answer: Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient

Discharge medicines reconciliation ensures intentional medication changes (stopped, started, dose changes) are documented, communicated to GP, and explained to the patient to prevent post-discharge errors.

Question 34: Which legislation governs the safe and secure handling of controlled drugs in England?

Misuse of Drugs Act 1971 only
Health Act 2006 and Controlled Drugs (Supervision of Management and Use) Regulations 2013 (Correct answer)
Medicines Act 1968
Human Medicines Regulations 2012

Correct answer: Health Act 2006 and Controlled Drugs (Supervision of Management and Use) Regulations 2013

The Health Act 2006 and CD Supervision Regulations 2013 established the Controlled Drugs Accountable Officer (CDAO) system for oversight and safe management of CDs in England.

Question 35: A patient with COPD is prescribed a LAMA/LABA combination inhaler. They continue to have frequent exacerbations. According to NICE, what should be considered next if the patient has features suggesting asthmatic/eosinophilic disease?

Switch to a short-acting bronchodilator only
Start prophylactic antibiotics
Escalate to triple therapy by adding an inhaled corticosteroid (ICS) (Correct answer)
Add oral theophylline

Correct answer: Escalate to triple therapy by adding an inhaled corticosteroid (ICS)

NICE recommends escalating to triple therapy (LAMA + LABA + ICS) for COPD patients with asthmatic features or raised eosinophils who continue to exacerbate despite dual bronchodilator therapy. The ICS component addresses the eosinophilic inflammation driving the exacerbations.

Question 36: What is the Henderson-Hasselbalch equation used for in pharmacy?

Calculating degree of drug ionisation (Correct answer)
Calculating infusion rates
Determining drug potency
Measuring osmolality

Correct answer: Calculating degree of drug ionisation

The Henderson-Hasselbalch equation relates pH, pKa, and the ratio of ionised to unionised drug, enabling prediction of ionisation state in body fluids.

Question 37: What is the WWHAM mnemonic used for in OTC consultations?

Weight, Waist, Height, Age, Medication — a health assessment
Who, What, How long, Action taken, Medication — a framework for OTC symptom consultation (Correct answer)
None of the above
Work, Welfare, Health, Advice, Management

Correct answer: Who, What, How long, Action taken, Medication — a framework for OTC symptom consultation

WWHAM (Who is it for? What are the symptoms? How long? Action taken? Medicines already taken?) is a structured framework pharmacists use to triage OTC requests and assess appropriateness of self-care.

Question 38: A dispensary receives a FP10MDA prescription for supervised methadone consumption. What does 'MDA' indicate?

Medical Device Authority approval
Multi-drug administration
Instalment dispensing prescription for controlled drugs (Correct answer)
Standard FP10 for any medication

Correct answer: Instalment dispensing prescription for controlled drugs

FP10MDA prescriptions are used for instalment dispensing of controlled drugs (typically methadone or buprenorphine in addiction treatment), specifying how frequently doses should be dispensed.

Question 39: Under which legislation is patient information sharing between healthcare professionals governed in the UK?

Mental Health Act 1983
Freedom of Information Act 2000
Health and Social Care Act 2012
UK GDPR and Data Protection Act 2018 (Correct answer)

Correct answer: UK GDPR and Data Protection Act 2018

UK GDPR (retained EU law) and the DPA 2018 govern how personal health data is processed and shared. Healthcare professionals must have a lawful basis for sharing patient information.

Question 40: Which of the following best describes medication adherence?

The ability of a patient to obtain and correctly fill their prescription
The patient's written agreement to take medication as prescribed
The extent to which a patient's behaviour corresponds with agreed recommendations from a healthcare provider (Correct answer)
The extent to which a patient follows their prescriber's instructions without question

Correct answer: The extent to which a patient's behaviour corresponds with agreed recommendations from a healthcare provider

Adherence describes correspondence between a patient's behaviour and agreed recommendations from a healthcare provider, reflecting a collaborative rather than prescriber-directed relationship.

Question 41: A patient states they regularly forget to take their once-daily antihypertensive because of a busy routine. This is an example of:

Medicines management failure
Therapeutic non-compliance
Unintentional non-adherence (Correct answer)
Intentional non-adherence

Correct answer: Unintentional non-adherence

Unintentional non-adherence occurs when patients want to take their medication but face practical barriers such as forgetfulness, rather than making a deliberate decision not to take it.

Question 42: What action is required if a community pharmacist identifies a prescription that appears to be forged?

Return it to the patient and ask them to get a new one
Retain the prescription, contact the prescriber to verify, and report to police/NHS Controlled Drugs team if confirmed forgery (Correct answer)
Dispense and report later
Call the GPhC immediately

Correct answer: Retain the prescription, contact the prescriber to verify, and report to police/NHS Controlled Drugs team if confirmed forgery

A forged CD prescription should not be dispensed. The pharmacist should retain it (it is evidence), verify with the prescriber, and report to police/NHS CD Accountable Officer if forgery is confirmed.

Question 43: What is meant by 'polypharmacy' and when does it become a concern?

Prescribing expensive medicines
Prescribing more than one medicine at any time
Use of multiple medicines; becomes a concern when it increases risk of interactions, side effects, and non-adherence (Correct answer)
Using medicines from more than one pharmacy

Correct answer: Use of multiple medicines; becomes a concern when it increases risk of interactions, side effects, and non-adherence

Polypharmacy (typically defined as ≥5 medicines) raises patient safety concerns due to increased drug interaction risk, adverse effects, pill burden, and adherence challenges, particularly in elderly patients.

Question 44: A cream is an example of which type of pharmaceutical system?

Emulsion (Correct answer)
Suspension
Solution
Gel

Correct answer: Emulsion

Creams are semi-solid emulsions (either O/W or W/O) intended for external application, consisting of two immiscible phases stabilised by an emulsifying agent.

Question 45: In a first-order elimination process, when plasma concentration doubles, the elimination rate:

Doubles (Correct answer)
Quadruples
Stays the same
Halves

Correct answer: Doubles

In first-order kinetics, the rate of elimination is proportional to the drug concentration. If concentration doubles, so does the elimination rate.

Question 46: Which body investigates concerns about fitness to practise for registered pharmacists?

NHS England
The GPhC Fitness to Practise Committee (Correct answer)
The Coroner
The Royal Pharmaceutical Society

Correct answer: The GPhC Fitness to Practise Committee

The GPhC's Fitness to Practise Committee investigates allegations of impairment through misconduct, poor performance, health issues, or criminal convictions affecting a pharmacist's registration.

Question 47: Which dispensing label warning is required for methotrexate?

'Do not take with dairy products'
'Avoid sunlight'
'Take with food'
'Caution — it is important to follow the dosage instructions given with this medicine' (Correct answer)

Correct answer: 'Caution — it is important to follow the dosage instructions given with this medicine'

Methotrexate carries a specific cautionary label because weekly dosing errors have caused deaths. The standard label emphasises following exact dosage instructions provided.

Question 48: An infusion of 500 mg in 250 mL is running at 50 mL/hour. What is the rate in mg/hour?

100 mg/hour (Correct answer)
200 mg/hour
25 mg/hour
50 mg/hour

Correct answer: 100 mg/hour

Concentration = 500/250 = 2 mg/mL. Rate = 2 mg/mL × 50 mL/hour = 100 mg/hour.

Question 49: A customer reports symptoms of cystitis (burning urination, frequency). Which patient should be referred without OTC treatment?

A non-pregnant woman with a 2-day history
A 25-year-old female with mild symptoms and no fever
A woman with recurrent confirmed UTIs
A pregnant woman with urinary symptoms (Correct answer)

Correct answer: A pregnant woman with urinary symptoms

Urinary symptoms in pregnancy require immediate GP referral. Pregnancy increases risk of ascending UTI, pyelonephritis, and premature labour. OTC urinary alkalising agents are not appropriate without GP review.

Question 50: Which sterilisation method is preferred for heat-labile products?

Dry heat sterilisation
Autoclaving
Gamma irradiation
Filtration through 0.22 µm membrane (Correct answer)

Correct answer: Filtration through 0.22 µm membrane

Membrane filtration (0.22 µm) physically removes microorganisms without heat, making it suitable for thermolabile solutions such as proteins or certain injectables.

Question 51: A drug with a narrow therapeutic index requires:

Increased dosing frequency
Wider dosing intervals
Lower protein binding
Therapeutic drug monitoring (Correct answer)

Correct answer: Therapeutic drug monitoring

Narrow therapeutic index drugs have a small margin between therapeutic and toxic doses, necessitating regular therapeutic drug monitoring (TDM) to ensure safety.

Question 52: A patient is found to be taking 12 different regular medications concurrently. This situation is best described as:

Hyperpharmacy
Polypharmacy (Correct answer)
Complex prescribing syndrome
Multimorbidity pharmacotherapy

Correct answer: Polypharmacy

Polypharmacy refers to the concurrent use of multiple medications; complex or problematic polypharmacy is typically defined as 10 or more medicines.

Question 53: What is the recommended first-line OTC treatment for head lice in the UK?

Malathion (Derbac-M) — organophosphate insecticide
Permethrin shampoo
Wet combing alone as per NICE
Dimeticone (Hedrin) — physical insecticide coating (Correct answer)

Correct answer: Dimeticone (Hedrin) — physical insecticide coating

NICE and PHE recommend dimeticone (e.g., Hedrin) as first-line for head lice. It physically coats and suffocates lice, avoiding insecticide resistance issues. Wet combing is an alternative if no products preferred.

Question 54: According to NICE, which drug is first-line for treating acute migraine attacks?

Sodium valproate
Triptans (e.g., sumatriptan) or analgesics + antiemetic (Correct answer)
Preventive beta-blockers
Opioid analgesics

Correct answer: Triptans (e.g., sumatriptan) or analgesics + antiemetic

NICE recommends a triptan combined with an NSAID or paracetamol plus an antiemetic for acute migraine. Opioids are not recommended due to risk of medication overuse headache.

Question 55: What is the percentage concentration (w/v) of a solution containing 2 g of drug in 250 mL?

0.4% w/v
0.8% w/v (Correct answer)
2% w/v
1% w/v

Correct answer: 0.8% w/v

2 g in 250 mL = 2/250 × 100 = 0.8% w/v. Percentage w/v = grams per 100 mL.

Question 56: Which antiepileptic drug is a potent inducer of hepatic CYP enzymes?

Carbamazepine (Correct answer)
Sodium valproate
Lamotrigine
Levetiracetam

Correct answer: Carbamazepine

Carbamazepine is a potent CYP3A4 and CYP2C9 inducer, accelerating metabolism of many co-administered drugs including warfarin, OCP, and other antiepileptics.

Question 57: A patient on warfarin presents with an INR of 8.5 with no active bleeding. According to NICE/BNF guidance, what is the most appropriate management?

Withhold warfarin and give oral vitamin K 1-5mg; recheck INR in 24 hours (Correct answer)
Continue warfarin at a reduced dose
Administer vitamin K 5mg intravenously immediately
Administer fresh frozen plasma

Correct answer: Withhold warfarin and give oral vitamin K 1-5mg; recheck INR in 24 hours

For an INR above 8.0 with no bleeding, the BNF recommends stopping warfarin and giving oral phytomenadione (vitamin K) 1-5mg. The INR should be rechecked after 24 hours. IV vitamin K and fresh frozen plasma are reserved for cases with major bleeding.

Question 58: A pharmacist needs to prepare 200mL of a 5% w/v solution from a 20% w/v stock solution and water. What volumes of stock solution and water are needed?

25mL stock + 175mL water
40mL stock + 160mL water
100mL stock + 100mL water
50mL stock + 150mL water (Correct answer)

Correct answer: 50mL stock + 150mL water

Using C₁V₁ = C₂V₂: 20% × V₁ = 5% × 200mL. V₁ = (5 × 200) ÷ 20 = 50mL of stock solution. Water needed = 200mL - 50mL = 150mL.

Question 59: What is the Electronic Prescription Service (EPS) Release 2?

A system allowing electronic transfer of prescriptions from prescriber to pharmacy with electronic signatures (Correct answer)
A digital patient medication record
An updated paper prescription format
A real-time drug interaction checker

Correct answer: A system allowing electronic transfer of prescriptions from prescriber to pharmacy with electronic signatures

EPS Release 2 enables the full electronic prescription workflow: the prescriber signs digitally, the prescription is sent electronically to the patient's nominated pharmacy, and the dispense is transmitted back to the NHS BSA.

Question 60: A patient requests their community pharmacist to provide a copy of their Summary Care Record (SCR). Under what circumstances can the pharmacist access the SCR?

Only in emergency situations when the patient is unconscious
At any time for any patient registered at a nearby GP surgery
Only with the patient's informed consent and for direct patient care purposes (Correct answer)
Whenever the pharmacist believes it would benefit the patient

Correct answer: Only with the patient's informed consent and for direct patient care purposes

Pharmacists can access the SCR with the patient's informed consent for the purpose of providing direct patient care. This includes understanding the patient's medication history, allergies, and adverse reactions. Access without consent is only permitted in specific emergency circumstances.

Question 61: A young woman requests emergency hormonal contraception (EHC). She reports unprotected intercourse 48 hours ago. Which option should the pharmacist recommend as the most effective oral EHC at this time point?

Levonorgestrel 1.5mg (effective up to 72 hours)
Ulipristal acetate 30mg (effective up to 120 hours) (Correct answer)
Both levonorgestrel and ulipristal are equally effective at 48 hours
Combined oral contraceptive pill as emergency use

Correct answer: Ulipristal acetate 30mg (effective up to 120 hours)

While both levonorgestrel and ulipristal acetate are licensed for emergency contraception, ulipristal acetate (ellaOne) maintains its efficacy better over time and is considered more effective than levonorgestrel between 24-120 hours after unprotected intercourse. At 48 hours, ulipristal is the preferred oral option. A copper IUD would be even more effective if available.

Question 62: What is the purpose of an enteric coating on a tablet?

To prevent dissolution in gastric acid (Correct answer)
To mask unpleasant taste
To speed up drug release
To improve appearance

Correct answer: To prevent dissolution in gastric acid

Enteric coatings resist gastric acid and dissolve in the higher pH of the small intestine, protecting acid-labile drugs or preventing gastric irritation.

Question 63: A solution has a pH of 3. What does this indicate?

Alkaline solution
Acidic solution (Correct answer)
Neutral solution
Buffered solution

Correct answer: Acidic solution

pH below 7 indicates an acidic solution. pH 7 is neutral; above 7 is alkaline. pH 3 is strongly acidic.

Question 64: What is the primary concern when prescribing NSAIDs to an elderly patient with chronic kidney disease?

Increased sodium retention only
Reduced analgesic effect
Increased bleeding time only
Worsening renal function due to prostaglandin inhibition reducing renal blood flow (Correct answer)

Correct answer: Worsening renal function due to prostaglandin inhibition reducing renal blood flow

NSAIDs inhibit prostaglandins that maintain renal vasodilation in patients with CKD. This can precipitate acute-on-chronic kidney injury, especially in elderly patients with reduced renal reserve.

Question 65: Which OTC product is appropriate for the treatment of athlete's foot (tinea pedis)?

Fusidic acid cream
Chloramphenicol ointment
Clotrimazole cream (Canesten) (Correct answer)
Hydrocortisone 1% cream

Correct answer: Clotrimazole cream (Canesten)

Clotrimazole is a topical imidazole antifungal effective against dermatophytes causing athlete's foot. Hydrocortisone is inappropriate (immunosuppressant, worsens fungal infection).

Question 66: A cream contains 0.025% w/w of betamethasone valerate. How many micrograms of betamethasone valerate are in 30g of the cream?

750 micrograms
750,000 micrograms
7,500 micrograms (Correct answer)
75,000 micrograms

Correct answer: 7,500 micrograms

0.025% w/w = 0.025g per 100g. In 30g: (0.025g ÷ 100g) × 30g = 0.0075g = 7.5mg = 7,500 micrograms.

Question 67: A patient on warfarin starts a course of amiodarone. What monitoring is required?

Increased INR monitoring; warfarin dose likely needs to be reduced (Correct answer)
INR monitoring can be stopped
No change needed
Amiodarone and warfarin cannot be co-prescribed

Correct answer: Increased INR monitoring; warfarin dose likely needs to be reduced

Amiodarone inhibits CYP2C9, reducing warfarin metabolism and significantly increasing INR. Warfarin dose often needs to be halved. Enhanced INR monitoring is essential when starting amiodarone.

Question 68: A patient weighing 70 kg requires a drug at 5 mg/kg/day in two divided doses. What is each dose?

87.5 mg
140 mg
350 mg
175 mg (Correct answer)

Correct answer: 175 mg

Total daily dose = 70 × 5 = 350 mg. Divided into 2 doses: 350 ÷ 2 = 175 mg per dose.

Question 69: A pharmacist is asked by police for patient medication records. What is the correct response?

Always comply with any police request
Disclose only with a court order, patient consent, or under a statutory gateway; refuse informal requests (Correct answer)
Ask the GP to decide
Refuse all police requests without exception

Correct answer: Disclose only with a court order, patient consent, or under a statutory gateway; refuse informal requests

Patient information is confidential under UK GDPR/DPA 2018. Pharmacists may disclose to police under statutory gateways (e.g., prevention of serious crime), court orders, or with patient consent — but not on informal request alone.

Question 70: A customer requests treatment for oral thrush. Which OTC product is first-line?

Chlorhexidine mouthwash
Miconazole oral gel (Daktarin) or nystatin suspension (Correct answer)
Amoxicillin
Hydrocortisone pellets

Correct answer: Miconazole oral gel (Daktarin) or nystatin suspension

Miconazole oral gel (Daktarin 2%) is the first-line OTC antifungal for oral thrush (candidiasis). Nystatin suspension is also used but is prescription-only in some formulations.

Question 71: How many millimoles of sodium are in 500mL of sodium chloride 0.9% infusion? (Molecular weight of NaCl = 58.5, Na = 23, Cl = 35.5)

154 mmol
77 mmol (Correct answer)
38.5 mmol
308 mmol

Correct answer: 77 mmol

NaCl 0.9% = 0.9g per 100mL = 4.5g per 500mL. Moles of NaCl = 4.5g ÷ 58.5g/mol = 0.0769 mol = 76.9 mmol. Since each NaCl molecule gives one Na⁺ ion, sodium content = 77 mmol. (Note: 154 mmol would be per litre.)

Question 72: Under the public health agenda, what is the pharmacist's responsibility regarding antimicrobial stewardship?

Antibiotics stewardship is solely the responsibility of hospital pharmacists
Prescribe antibiotics for self-limiting conditions to prevent complications
Promote appropriate antibiotic use, advise patients on self-limiting infections, and support national campaigns to reduce antimicrobial resistance (Correct answer)
Supply antibiotics over the counter to reduce GP workload

Correct answer: Promote appropriate antibiotic use, advise patients on self-limiting infections, and support national campaigns to reduce antimicrobial resistance

Community pharmacists play a key role in antimicrobial stewardship by advising patients that many infections are self-limiting, recommending symptomatic relief, supporting the TARGET toolkit and Antibiotic Awareness campaigns, and ensuring appropriate antibiotic supply. This helps combat antimicrobial resistance, which the WHO identifies as a major global health threat.

Question 73: What is the significance of the QT interval on an ECG in the context of drug safety?

Shortened QT is the main drug safety concern
QT prolongation increases risk of fatal ventricular arrhythmia (torsades de pointes) (Correct answer)
QT interval is only relevant in paediatrics
QT prolongation indicates kidney failure

Correct answer: QT prolongation increases risk of fatal ventricular arrhythmia (torsades de pointes)

Drug-induced QT prolongation delays ventricular repolarisation, increasing risk of torsades de pointes (TdP), a polymorphic ventricular tachycardia that can degenerate into ventricular fibrillation and death.

Question 74: Which monitoring should be performed in a patient started on clozapine?

Serum creatinine only
Blood glucose only
Full blood count (FBC) — monitoring for agranulocytosis (Correct answer)
Liver function tests only

Correct answer: Full blood count (FBC) — monitoring for agranulocytosis

Clozapine monitoring requires regular FBC because the drug causes agranulocytosis in up to 1% of patients, which can be fatal if undetected. Monitoring frequency decreases as treatment duration increases.

Question 75: A patient with type 2 diabetes requests an OTC decongestant for a blocked nose. What is the concern?

No concern — OTC decongestants are safe in diabetes
Pseudoephedrine and phenylephrine can raise blood glucose and blood pressure (Correct answer)
Only nasal drops are contraindicated
Decongestants lower blood glucose

Correct answer: Pseudoephedrine and phenylephrine can raise blood glucose and blood pressure

Oral sympathomimetic decongestants (pseudoephedrine, phenylephrine) can raise blood glucose via glycogenolysis and raise blood pressure, making them unsuitable without medical advice in diabetics.

Question 76: What is the definition of a 'wholesale dealer' under the Human Medicines Regulations 2012?

A person who sells or supplies medicines for the purpose of sale or supply by others (Correct answer)
A hospital purchasing medicines for inpatient use
A pharmacist supplying to patients
A GP dispensing to their own patients

Correct answer: A person who sells or supplies medicines for the purpose of sale or supply by others

A wholesale dealer supplies medicines to others who will then sell or supply them (e.g., pharmacies, hospitals), as opposed to a retail sale directly to patients or end users.

Question 77: A child weighing 22kg requires amoxicillin at a dose of 25mg/kg/day in three divided doses. The suspension available is 250mg/5mL. What volume should be given per dose?

7.3mL (Correct answer)
22mL
11mL
3.7mL

Correct answer: 7.3mL

Total daily dose = 25mg/kg × 22kg = 550mg/day. Per dose = 550mg ÷ 3 = 183.3mg. Volume = (183.3mg ÷ 250mg) × 5mL = 3.67mL, rounded to 3.7mL per dose.

Question 78: A patient requests a repeat dispensing of their regular atorvastatin. The repeat dispensing authorisation has expired. What should the pharmacist do?

Make an emergency supply to cover the patient while they obtain a new prescription or repeat dispensing authorisation from their GP (Correct answer)
Continue dispensing from the expired authorisation
Dispense one more supply as a courtesy
Refuse any supply and tell the patient to see their GP

Correct answer: Make an emergency supply to cover the patient while they obtain a new prescription or repeat dispensing authorisation from their GP

An expired repeat dispensing authorisation cannot be used. However, to ensure continuity of treatment for a long-term medicine, the pharmacist can consider making an emergency supply at the patient's request (under Human Medicines Regulations 2012) while advising them to obtain a new authorisation from their GP promptly.

Question 79: A patient's prescription specifies 'metformin 500mg tablets — 56 tablets'. The pharmacy has both standard and modified-release metformin 500mg in stock. Which should be dispensed?

Only the standard-release formulation, as modified-release would need to be specified on the prescription (Correct answer)
Either formulation can be dispensed as the dose is the same
The modified-release formulation as it has better compliance
Whichever is cheaper for the pharmacy

Correct answer: Only the standard-release formulation, as modified-release would need to be specified on the prescription

Standard-release and modified-release formulations are not interchangeable. If the prescription simply states 'metformin 500mg tablets' without specifying MR or SR, the standard-release formulation should be dispensed. Modified-release formulations have different pharmacokinetic profiles, dosing schedules, and are prescribed specifically when intended.

Question 80: Which NICE guideline specifically addresses medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes?

NG15
NG76
NG5 (Correct answer)
NG28

Correct answer: NG5

NICE guideline NG5, published in 2015, sets out the key principles and recommendations for medicines optimisation in the NHS.

Question 81: What does a drug's half-life determine?

Volume of distribution
Bioavailability
Time to reach steady state (Correct answer)
Peak plasma concentration

Correct answer: Time to reach steady state

Steady state is reached after approximately 4–5 half-lives. Half-life does not directly determine Cmax, Vd, or bioavailability.

Question 82: What is the responsible pharmacist's legal obligation regarding the pharmacy's standard operating procedures (SOPs)?

SOPs are only required for controlled drug dispensing
SOPs only need to be reviewed annually by the superintendent pharmacist
SOPs are optional guidelines that may be followed at discretion
The responsible pharmacist must ensure SOPs are in place and are followed during their period of responsibility (Correct answer)

Correct answer: The responsible pharmacist must ensure SOPs are in place and are followed during their period of responsibility

Under the Medicines (Pharmacies) (Responsible Pharmacist) Regulations 2008, the responsible pharmacist must ensure that appropriate SOPs are in place and are being followed during the period they are the responsible pharmacist. This is a legal, not merely professional, requirement.

Question 83: A 70-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the most appropriate anticoagulation strategy according to NICE?

No anticoagulation needed at this score
Clopidogrel 75mg daily
A direct oral anticoagulant (DOAC) such as apixaban or edoxaban (Correct answer)
Aspirin 75mg daily

Correct answer: A direct oral anticoagulant (DOAC) such as apixaban or edoxaban

NICE recommends offering anticoagulation to patients with a CHA₂DS₂-VASc score of 2 or above. DOACs (apixaban, dabigatran, edoxaban, rivaroxaban) are recommended as options. Aspirin monotherapy is no longer recommended for stroke prevention in atrial fibrillation.

Question 84: A prescription for 'MST Continus 30mg tablets' is presented. What does 'MST Continus' indicate?

A brand name for methadone
Codeine phosphate tablets
Immediate-release morphine
Modified-release morphine sulfate tablets (Correct answer)

Correct answer: Modified-release morphine sulfate tablets

MST Continus is a brand of modified-release morphine sulfate tablets, providing 12-hourly controlled release. This is a Schedule 2 CD requiring full CD prescription requirements.

Question 85: A pharmacist suspects a prescription may be forged. What is the correct first action?

Contact the prescriber to verify the prescription (Correct answer)
Dispense the prescription and report later
Refuse dispensing and call the police immediately
Ask the patient to return with a new prescription

Correct answer: Contact the prescriber to verify the prescription

The first step is to verify authenticity by contacting the prescriber directly using a verified number (not one on the prescription). Dispensing a forged prescription is a criminal offence.

Question 86: Which route of administration avoids first-pass metabolism most effectively?

Intravenous (Correct answer)
Rectal
Oral
Sublingual

Correct answer: Intravenous

Intravenous administration delivers drug directly into systemic circulation, completely bypassing first-pass hepatic metabolism.

Question 87: A patient brings in a prescription marked 'RP' (repeat prescribing). How many times can the pharmacist dispense from this single prescription?

Twice — original plus one repeat
Once only
Unlimited times within 12 months
Up to the number of repeat issues authorised by the prescriber on the prescription (Correct answer)

Correct answer: Up to the number of repeat issues authorised by the prescriber on the prescription

Repeat dispensing allows a prescriber to authorise multiple issues on a single prescription. The number of repeats is specified by the prescriber (typically 6-12 monthly issues for stable long-term conditions). Each issue must be dispensed within the specified interval, and the pharmacist must clinically check at each dispensing.

Question 88: The BNF recommends stopping which drug at least 48 hours before iodine-containing contrast media in patients with eGFR <60?

Metformin (Correct answer)
Omeprazole
Amlodipine
Atorvastatin

Correct answer: Metformin

Metformin should be withheld before iodinated contrast to prevent contrast-induced nephropathy potentially leading to lactic acidosis due to reduced renal clearance.

Question 89: Which NSAID is associated with the lowest cardiovascular risk according to current evidence?

Celecoxib
Diclofenac
Ibuprofen high-dose
Naproxen (Correct answer)

Correct answer: Naproxen

Naproxen is generally considered to have the lowest cardiovascular risk among NSAIDs due to its platelet inhibitory effects resembling aspirin, though GI risk remains.

Question 90: Which drug class is contraindicated in patients with asthma who require antihypertensive therapy?

Non-selective beta-blockers (Correct answer)
ACE inhibitors
Calcium channel blockers
Thiazide diuretics

Correct answer: Non-selective beta-blockers

Non-selective beta-blockers (e.g., propranolol) block beta-2 receptors in the bronchi, causing bronchoconstriction and worsening asthma. Even cardioselective beta-blockers should be used cautiously.

Question 91: A patient taking clarithromycin is also prescribed simvastatin. What is the major concern?

Hepatotoxicity from clarithromycin alone
Increased clarithromycin levels
Reduced antibiotic efficacy
Myopathy and rhabdomyolysis due to raised statin levels (Correct answer)

Correct answer: Myopathy and rhabdomyolysis due to raised statin levels

Clarithromycin inhibits CYP3A4, significantly increasing simvastatin levels. This dramatically raises the risk of myopathy and rhabdomyolysis. Simvastatin should be suspended during clarithromycin treatment.

Question 92: A pharmacy is commissioned to provide NHS Health Checks. Which age group is the target population for this cardiovascular disease risk assessment programme?

All adults regardless of age or medical history
Adults aged 18-39
Adults aged 65 and over only
Adults aged 40-74 without pre-existing cardiovascular disease (Correct answer)

Correct answer: Adults aged 40-74 without pre-existing cardiovascular disease

NHS Health Checks target adults aged 40-74 who do not already have a diagnosed cardiovascular condition (heart disease, stroke, diabetes, kidney disease). The check assesses cardiovascular risk through measurements including blood pressure, cholesterol, BMI, and lifestyle factors, with the aim of early intervention.

Question 93: What is the legal requirement for a Responsible Pharmacist to do when leaving the pharmacy premises?

Display a notice showing another responsible pharmacist has been appointed or close the pharmacy (Correct answer)
Inform all customers verbally
Designate a pharmacy technician to supervise
Leave the prescription counter unattended temporarily

Correct answer: Display a notice showing another responsible pharmacist has been appointed or close the pharmacy

Regulations require either displaying notice that a new RP has been appointed, or closing the pharmacy while the RP is absent for more than two hours.

Question 94: A pharmacy provides supervised consumption of methadone as part of an opioid substitution therapy programme. What is the primary reason for supervised consumption?

To allow the pharmacist to monitor for allergic reactions
To ensure the patient takes the medicine at the correct time of day
To prevent diversion of methadone to others and reduce the risk of accidental overdose, particularly in early treatment (Correct answer)
Supervised consumption is only required for the first dose

Correct answer: To prevent diversion of methadone to others and reduce the risk of accidental overdose, particularly in early treatment

Supervised consumption ensures the patient takes the methadone themselves, preventing diversion to others (including children, who are at high risk of fatal overdose from even small amounts). It is most critical in the early stages of treatment when the correct dose is being established and the risk of overdose is highest.

Question 95: A patient taking warfarin is prescribed clarithromycin. What interaction should you counsel about?

Decreased INR
Reduced warfarin absorption
Increased INR and bleeding risk (Correct answer)
No clinically significant interaction

Correct answer: Increased INR and bleeding risk

Clarithromycin inhibits CYP3A4 and CYP2C9, reducing warfarin metabolism and increasing anticoagulant effect, raising INR and bleeding risk.

Question 96: What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

Stimulate postsynaptic serotonin receptors directly
Block serotonin reuptake at the presynaptic terminal (Correct answer)
Inhibit MAO enzymes
Increase serotonin synthesis

Correct answer: Block serotonin reuptake at the presynaptic terminal

SSRIs inhibit the serotonin transporter (SERT), preventing reuptake of serotonin into the presynaptic neuron, increasing serotonin availability in the synapse.

Question 97: A patient on spironolactone and an ACE inhibitor develops muscle weakness. What electrolyte abnormality is most likely?

Hyperkalaemia (Correct answer)
Hypokalaemia
Hypercalcaemia
Hyponatraemia

Correct answer: Hyperkalaemia

Both spironolactone (potassium-sparing diuretic) and ACE inhibitors increase serum potassium. Combination therapy can cause dangerous hyperkalaemia, manifesting as muscle weakness or arrhythmias.

Question 98: A pharmacist needs to dilute a 95% v/v ethanol solution to produce 500mL of 70% v/v ethanol. What volume of the 95% solution is required?

263mL
432mL
475mL
368mL (Correct answer)

Correct answer: 368mL

Using C₁V₁ = C₂V₂: 95% × V₁ = 70% × 500mL. V₁ = (70 × 500) ÷ 95 = 35,000 ÷ 95 = 368.4mL. Therefore approximately 368mL of the 95% solution is needed, made up to 500mL with purified water.

Question 99: Which polymorphic form of a drug is generally more soluble?

Anhydrous form
Amorphous form (Correct answer)
Crystalline form
Hydrate form

Correct answer: Amorphous form

Amorphous solids lack a regular crystal lattice, making them more soluble and often more bioavailable than crystalline forms of the same drug.

Question 100: What is the maximum quantity of codeine linctus a pharmacist may sell to one customer over the counter under current guidelines?

Any amount up to 500 mL
One 100 mL bottle (limiting to small quantities) (Correct answer)
Unlimited if the patient insists
Only on prescription

Correct answer: One 100 mL bottle (limiting to small quantities)

Sales of codeine-containing preparations should be limited to small quantities (typically one pack/bottle). Pharmacists must use professional judgment to prevent misuse and dependence.

Question 101: What is the pharmacist's role in needle and syringe exchange programmes (NSP) as part of harm reduction for injecting drug users?

Only provide needles if the person agrees to enter a treatment programme
Pharmacists should refuse to participate as it encourages drug use
Refer all clients to their GP without providing any equipment
Provide clean needles/syringes, sharps bins, and advice on safer injecting practices to reduce blood-borne virus transmission (Correct answer)

Correct answer: Provide clean needles/syringes, sharps bins, and advice on safer injecting practices to reduce blood-borne virus transmission

Needle and syringe programmes are evidence-based harm reduction interventions that significantly reduce transmission of blood-borne viruses (HIV, hepatitis B and C) among injecting drug users. Community pharmacies provide clean equipment, sharps disposal, and health advice without requiring engagement in treatment as a precondition.

Question 102: When dispensing a prescription for a Schedule 2 controlled drug, what specific record must be made in the controlled drug register?

Date of supply, name and address of the patient, prescriber details, quantity supplied, and the running balance (Correct answer)
Only the drug name and quantity
Just the patient's name and date
No register entry is required for Schedule 2 drugs dispensed on NHS prescriptions

Correct answer: Date of supply, name and address of the patient, prescriber details, quantity supplied, and the running balance

The Misuse of Drugs Regulations 2001 require comprehensive entries in the CD register for Schedule 2 drugs including: date of supply, drug name/form/strength, quantity supplied, person collecting, prescriber name and address, and (good practice) a running balance. Entries must be made on the day of supply or the next day.

Question 103: Under the Medicines Act 1968, which category of medicines can only be sold or supplied from a registered pharmacy by or under the supervision of a pharmacist?

Pharmacy (P) medicines (Correct answer)
Controlled drugs only
Prescription Only Medicines (POMs)
General Sale List (GSL) medicines

Correct answer: Pharmacy (P) medicines

Pharmacy (P) medicines must be sold from a registered pharmacy under the supervision of a pharmacist. POMs require a prescription, GSL medicines can be sold from any retail outlet, and controlled drugs are a subset of POMs with additional restrictions.

Question 104: What is the significance of a drug's pKa?

It determines the degree of ionisation at a given pH (Correct answer)
It measures lipid solubility
It indicates the drug's protein binding affinity
It predicts renal clearance directly

Correct answer: It determines the degree of ionisation at a given pH

pKa is the pH at which 50% of the drug is ionised. It helps predict ionisation state at physiological pH, influencing absorption and distribution.

Question 105: A pharmacist prepares 500mL of an oral solution. The displacement value of the suspended powder is 0.8mL/g, and 25g of powder is used. What volume of vehicle is needed?

475mL
500mL
480mL (Correct answer)
520mL

Correct answer: 480mL

Displacement volume of powder = 25g × 0.8mL/g = 20mL. The powder displaces 20mL when suspended. Therefore, vehicle needed = 500mL - 20mL = 480mL to give a final volume of 500mL.

Question 106: A suppository base that melts at body temperature is described as:

Theobroma oil base (Correct answer)
Hydrophilic base
Glycerin base
Macrogol base

Correct answer: Theobroma oil base

Theobroma oil (cocoa butter) melts at approximately 34–35°C, close to body temperature, making it suitable for rectal suppositories.

Question 107: A dispensing error has occurred in the pharmacy. According to best practice, what should the pharmacy do after ensuring patient safety?

Discipline the staff member responsible immediately
Conduct a root cause analysis and report the error through the local incident reporting system (Correct answer)
Keep the error confidential to protect staff morale
Only report if the patient was actually harmed

Correct answer: Conduct a root cause analysis and report the error through the local incident reporting system

A just culture approach requires root cause analysis to identify system failures rather than blaming individuals. All errors should be reported through the incident reporting system (such as NRLS/LFPSE) regardless of whether harm occurred, as near-misses provide valuable learning opportunities for preventing future errors.

Question 108: Buprenorphine patches used for pain management are classified in which CD schedule?

Schedule 3 (Correct answer)
Schedule 5
Schedule 2
Schedule 4

Correct answer: Schedule 3

Buprenorphine is a Schedule 3 CD. Unlike Schedule 2 CDs, it does not require a CD register entry in community pharmacy but does require safe custody.

Question 109: Which of the following best describes the concept of medicines optimisation as defined by NICE?

Ensuring patients take all prescribed medications at the correct dose
A person-centred approach to safe and effective medicines use to achieve the best possible outcomes (Correct answer)
Minimising the total number of medications a patient takes
Ensuring prescribers adhere strictly to national formulary guidelines

Correct answer: A person-centred approach to safe and effective medicines use to achieve the best possible outcomes

NICE defines medicines optimisation as a person-centred approach to safe and effective medicines use to help patients achieve the best possible outcomes.

Question 110: Which of the following is NOT a legal requirement on an NHS FP10 prescription form?

Patient's name and address
The patient's NHS number (Correct answer)
Date of prescribing
Prescriber's signature

Correct answer: The patient's NHS number

The NHS number is not a legal prescription requirement, though it is increasingly used for identification. Legal requirements include patient name/address, drug, dose, quantity, prescriber signature, and date.

Question 111: A patient asks about the NHS community pharmacy blood pressure check service. What does this service involve?

The service is only available in hospital settings
Identification of adults aged 40+ with undiagnosed hypertension through clinic BP measurement, followed by ambulatory monitoring or referral as needed (Correct answer)
A single blood pressure reading with no follow-up
Blood pressure checks only for patients already diagnosed with hypertension

Correct answer: Identification of adults aged 40+ with undiagnosed hypertension through clinic BP measurement, followed by ambulatory monitoring or referral as needed

The NHS community pharmacy blood pressure check service targets adults aged 40 and over to identify undiagnosed hypertension. It involves clinic blood pressure measurement and, where readings are elevated, the pharmacy may provide ambulatory blood pressure monitoring (ABPM) or refer to the GP for further assessment and diagnosis.

Question 112: Which type of interaction occurs when two drugs compete for the same plasma protein binding site?

Synergistic interaction
Pharmacokinetic displacement interaction (Correct answer)
Pharmacodynamic interaction
Additive interaction

Correct answer: Pharmacokinetic displacement interaction

Protein binding displacement is a pharmacokinetic interaction where one drug displaces another from albumin or other proteins, increasing free drug concentration.

Question 113: A patient is started on ramipril for hypertension. After two weeks, blood tests show a rise in serum creatinine of 35% from baseline. What is the most appropriate action?

This is expected; continue ramipril and recheck in 3 months
Add a calcium channel blocker to protect the kidneys
Stop ramipril immediately and investigate for renal artery stenosis (Correct answer)
Reduce the dose by half and recheck in 2 weeks

Correct answer: Stop ramipril immediately and investigate for renal artery stenosis

A rise in serum creatinine of more than 30% from baseline after starting an ACE inhibitor suggests possible renal artery stenosis and the drug should be stopped. A rise of up to 30% is considered acceptable and the drug can be continued with monitoring. This patient's 35% rise exceeds the acceptable threshold.

Question 114: The GPhC principle 'Act with Professionalism and Integrity' includes which behaviour?

Being honest even when mistakes occur (Correct answer)
Only acting professionally when being observed
Prioritising business interests over patient safety
Avoiding documentation of errors

Correct answer: Being honest even when mistakes occur

Acting with integrity requires honesty and transparency at all times, including when things go wrong. This underpins patient trust and the open culture needed for safety learning.

Question 115: Which drug is used to reverse the effects of paracetamol overdose?

N-acetylcysteine (Parvolex) (Correct answer)
Protamine sulfate
Flumazenil
Naloxone

Correct answer: N-acetylcysteine (Parvolex)

N-acetylcysteine (NAC) replenishes glutathione, preventing accumulation of NAPQI (the toxic paracetamol metabolite) and treating hepatotoxicity in overdose.

Question 116: A pharmacist suspects a customer is buying excessive quantities of pseudoephedrine-containing cold remedies. What should they do?

Contact the manufacturer
Sell them regardless — it is OTC
Refuse the sale, record the incident, and consider reporting to police if diversion for drug manufacture is suspected (Correct answer)
Sell a smaller quantity and ask no questions

Correct answer: Refuse the sale, record the incident, and consider reporting to police if diversion for drug manufacture is suspected

Pseudoephedrine is a precursor for methamphetamine synthesis. Pharmacists have a legal and professional duty to refuse suspicious sales, record concerns, and report suspected diversion to police or NHS.

Question 117: Which schedule of the Misuse of Drugs Regulations exempts certain preparations from CD safe custody requirements?

Schedule 5 (Correct answer)
Schedule 3
Schedule 1
Schedule 2

Correct answer: Schedule 5

Schedule 5 preparations (e.g., low-strength codeine linctus, dihydrocodeine preparations) are exempt from most CD controls including safe custody, requisitions, and registers.

Question 118: A patient with heart failure is prescribed furosemide. Which electrolyte should be routinely monitored?

Magnesium
Phosphate
Calcium
Potassium (Correct answer)

Correct answer: Potassium

Loop diuretics like furosemide cause significant urinary potassium loss, leading to hypokalaemia which can precipitate arrhythmias, especially in patients on digoxin.

Question 119: Which drug class is first-line for preventing recurrent gout attacks?

Xanthine oxidase inhibitors (allopurinol) (Correct answer)
Corticosteroids
NSAIDs
Colchicine

Correct answer: Xanthine oxidase inhibitors (allopurinol)

Allopurinol (xanthine oxidase inhibitor) lowers uric acid production and is the mainstay of long-term urate-lowering therapy to prevent recurrent gout.

Question 120: A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 2 (male) should receive:

Anticoagulation with apixaban or warfarin (Correct answer)
Aspirin alone
Rate control only
No treatment needed

Correct answer: Anticoagulation with apixaban or warfarin

NICE recommends anticoagulation for males with CHA₂DS₂-VASc ≥2. A score of 2 warrants anticoagulation with a DOAC (e.g., apixaban) or warfarin.

Question 121: A patient weighing 70kg requires gentamicin at 5mg/kg/day administered in two divided doses. Gentamicin injection is available as 80mg/2mL. What volume is needed per dose?

3.5mL
4.38mL (Correct answer)
2.19mL
8.75mL

Correct answer: 4.38mL

Daily dose = 5mg/kg × 70kg = 350mg. Per dose = 350 ÷ 2 = 175mg. Concentration = 80mg/2mL = 40mg/mL. Volume = 175mg ÷ 40mg/mL = 4.375mL, approximately 4.38mL.

Question 122: Which solubility enhancing technique involves forming a complex between drug and cyclodextrin?

Complexation (Correct answer)
Salt formation
Micronisation
Co-solvency

Correct answer: Complexation

Cyclodextrins form inclusion complexes with poorly water-soluble drugs, enhancing their solubility and bioavailability without chemical modification.

Question 123: What is a 'specials' medicine in the context of UK pharmacy?

A medicine on shortage
A hospital-only formulary medicine
An unlicensed medicine manufactured to meet a specific clinical need not met by licensed products (Correct answer)
A particularly expensive medicine

Correct answer: An unlicensed medicine manufactured to meet a specific clinical need not met by licensed products

Specials are unlicensed medicines manufactured under a Manufacturer's Specials Licence (MS) when no licensed product is suitable for a patient's individual clinical need (e.g., specific dose, formulation, or excipient-free version).

Question 124: What is 'off-label' prescribing?

Prescribing a medicine outside its licensed indications, age, dose, or route (Correct answer)
Prescribing a controlled drug
Prescribing a generic medicine
Dispensing without a prescription

Correct answer: Prescribing a medicine outside its licensed indications, age, dose, or route

Off-label use means a licensed medicine is used in a way not covered by its marketing authorisation (e.g., different indication, age group, or dose). The prescriber takes clinical responsibility.

Question 125: Which property of a drug most influences its ability to cross the blood-brain barrier?

Lipophilicity (Correct answer)
Molecular weight only
Protein binding
Renal clearance

Correct answer: Lipophilicity

Lipophilic (fat-soluble) drugs cross the blood-brain barrier more readily because the barrier is composed mainly of lipid bilayer membranes.

Question 126: Which drug interaction should be identified when a patient on ramipril is prescribed potassium supplementation?

Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels (Correct answer)
Hypokalaemia risk
No significant interaction
Reduced ramipril efficacy

Correct answer: Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels

ACE inhibitors reduce angiotensin II-mediated aldosterone secretion, decreasing urinary potassium excretion. Adding potassium supplements increases hyperkalaemia risk, potentially causing dangerous arrhythmias.

Question 127: What is the 'medication adherence' concept and why is it clinically important?

How often patients visit their pharmacy
How quickly patients refill prescriptions
Whether medicines are stored correctly
Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications (Correct answer)

Correct answer: Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications

Medication adherence refers to how consistently a patient takes medicines as prescribed. Poor adherence is a major cause of treatment failure, disease progression, and preventable hospital admissions.

Question 128: The GPhC Pharmacist Independent Prescriber qualification allows prescribing:

Any medicine within their competence, including Schedule 2 and 3 CDs (except diamorphine for addiction) (Correct answer)
Only in hospital settings
Only from a limited formulary
Only GSL medicines

Correct answer: Any medicine within their competence, including Schedule 2 and 3 CDs (except diamorphine for addiction)

GPhC-qualified pharmacist independent prescribers can prescribe any licensed medicine within their competence, including CDs (except diamorphine and cocaine for addiction treatment).

Question 129: The STOPP/START criteria are primarily used to:

Identify potentially inappropriate medications and omissions in older patients (Correct answer)
Calculate renal dose adjustments for commonly prescribed drugs
Assess patient adherence to long-term medication regimens
Screen for drug interactions in patients on polypharmacy

Correct answer: Identify potentially inappropriate medications and omissions in older patients

STOPP (Screening Tool of Older People's Prescriptions) identifies potentially inappropriate medicines and START (Screening Tool to Alert to Right Treatment) identifies treatment omissions in older patients.

Question 130: Zeta potential is used to assess:

Chemical stability of solutions
Dissolution rate
Physical stability of colloidal dispersions (Correct answer)
Microbial contamination

Correct answer: Physical stability of colloidal dispersions

Zeta potential measures the electrostatic charge on colloidal particles. A high absolute zeta potential (>±30 mV) indicates good electrostatic repulsion and physical stability.

Question 131: What is the shelf life of a reconstituted oral antibiotic suspension typically?

7–14 days refrigerated (Correct answer)
30 days at room temperature
2 years
6 months

Correct answer: 7–14 days refrigerated

Most reconstituted antibiotic suspensions (e.g., amoxicillin) are stable for 7–14 days when stored in a refrigerator after reconstitution.

Question 132: Which Schedule of the Misuse of Drugs Regulations 2001 includes morphine and diamorphine?

Schedule 2 (Correct answer)
Schedule 1
Schedule 5
Schedule 3

Correct answer: Schedule 2

Schedule 2 includes drugs with accepted medical use but high misuse potential (e.g., morphine, diamorphine, fentanyl, pethidine), subject to full CD controls.

Question 133: A patient presents a private prescription for a Schedule 2 controlled drug. Which of the following is NOT a legal requirement for this prescription to be valid?

The prescriber's GPhC registration number (Correct answer)
The patient's name and address
The prescriber's signature in ink
The total quantity in both words and figures

Correct answer: The prescriber's GPhC registration number

Private prescriptions for Schedule 2 controlled drugs must include the patient's name and address, dose, total quantity in words and figures, and the prescriber's signature. The prescriber's GPhC number is not required — a prescriber identification number from the relevant regulatory body is needed, not the GPhC number specifically.

Question 134: What is the role of a surfactant in pharmaceutical formulations?

Increases viscosity
Provides antimicrobial activity
Acts as a colouring agent
Reduces surface tension to improve wetting and emulsification (Correct answer)

Correct answer: Reduces surface tension to improve wetting and emulsification

Surfactants (surface-active agents) reduce surface tension at interfaces, aiding wetting, emulsification, solubilisation, and dispersion of poorly soluble drugs.

Question 135: Which health promotion campaign involves pharmacists advising patients to complete the full course of prescribed antibiotics and not to share them with others?

Change4Life
Stoptober
Antibiotic Guardian / European Antibiotic Awareness Week (Correct answer)
Dry January

Correct answer: Antibiotic Guardian / European Antibiotic Awareness Week

The Antibiotic Guardian campaign and European Antibiotic Awareness Week (November) promote responsible antibiotic use. Key messages include completing prescribed courses, not sharing antibiotics, not saving leftover antibiotics, and understanding that antibiotics do not work for viral infections. Pharmacists are encouraged to become Antibiotic Guardians.

Question 136: Which opioid analgesic has the highest oral bioavailability?

Morphine
Tramadol
Methadone (Correct answer)
Codeine

Correct answer: Methadone

Methadone has oral bioavailability of approximately 80–95%, significantly higher than morphine (~35%), making it effective orally. It also has a long half-life.

Question 137: A patient requires 250 mg of amoxicillin. The suspension available is 125 mg/5 mL. What volume should be dispensed?

5 mL
2.5 mL
15 mL
10 mL (Correct answer)

Correct answer: 10 mL

250 mg ÷ 125 mg × 5 mL = 10 mL. This is a standard concentration calculation.

Question 138: A pharmacist suspects a prescription has been forged. What is the most appropriate initial action?

Return the prescription to the patient and ask them to get a new one
Refuse to dispense, retain the prescription, and contact the prescriber to verify its authenticity (Correct answer)
Dispense the prescription but alert the police afterwards
Dispense half the quantity as a compromise

Correct answer: Refuse to dispense, retain the prescription, and contact the prescriber to verify its authenticity

If a pharmacist suspects forgery, they should not dispense the prescription. The prescription should be retained and the prescriber contacted to verify authenticity. If forgery is confirmed, the police should be informed. Dispensing a suspected forged prescription could facilitate drug misuse and is a breach of professional duty.

Question 139: Which of the following scenarios would require the pharmacist to intervene under the NHS safeguarding framework?

A young adult requesting the morning-after pill
A parent buying paracetamol suspension for their child with a fever
A teenager buying acne treatment
An elderly patient with unexplained bruising who appears fearful and is accompanied by an aggressive relative (Correct answer)

Correct answer: An elderly patient with unexplained bruising who appears fearful and is accompanied by an aggressive relative

Pharmacists have a duty of care under safeguarding legislation to recognise and report concerns about vulnerable adults and children. Unexplained bruising combined with fearful behaviour and an aggressive companion are recognised indicators of potential abuse or coercion. The pharmacist should follow local safeguarding procedures.

Question 140: Which proton pump inhibitor has the most significant interaction with clopidogrel?

Esomeprazole
Pantoprazole
Lansoprazole
Omeprazole (Correct answer)

Correct answer: Omeprazole

Omeprazole and esomeprazole are potent CYP2C19 inhibitors, reducing conversion of clopidogrel to its active metabolite. Pantoprazole has the least effect.

Question 141: According to NICE guidelines, what is the first-line treatment for newly diagnosed type 2 diabetes alongside lifestyle advice?

Metformin (Correct answer)
Gliclazide
Sitagliptin
Insulin glargine

Correct answer: Metformin

NICE recommends metformin as first-line pharmacotherapy for type 2 diabetes, provided renal function is adequate (eGFR ≥30 mL/min/1.73m²).

Question 142: Under the Equality Act 2010, a pharmacy must make reasonable adjustments for disabled patients. Which of the following is an example of a reasonable adjustment?

Charging extra for home delivery to disabled patients
Requiring all patients to collect prescriptions in person
Providing written information in large print for a visually impaired patient (Correct answer)
Refusing to serve patients who cannot communicate verbally

Correct answer: Providing written information in large print for a visually impaired patient

The Equality Act 2010 requires service providers to make reasonable adjustments to ensure disabled people are not placed at a substantial disadvantage. Providing large print information is a practical adjustment that removes a barrier to accessing pharmacy services.

Question 143: Under the Equality Act 2010, a pharmacy must make 'reasonable adjustments' for patients with disabilities. An example includes:

Referring all disabled patients to hospital
Providing large-print labels or offering a private consultation area (Correct answer)
Only seeing able-bodied patients
Charging extra for adaptations

Correct answer: Providing large-print labels or offering a private consultation area

Reasonable adjustments under the Equality Act might include accessible premises, large-print or audio labels, or private areas for patients with communication or hearing difficulties.

Question 144: What is the recommended duration of dual antiplatelet therapy after a drug-eluting coronary stent?

12 months (Correct answer)
1 month
3 months
Indefinitely

Correct answer: 12 months

NICE and cardiology guidelines recommend 12 months of dual antiplatelet therapy (aspirin + P2Y12 inhibitor) following drug-eluting stent insertion to prevent stent thrombosis.

Question 145: Which formulation type is designed to release drug over an extended period to reduce dosing frequency?

Modified-release tablet (Correct answer)
Enteric-coated tablet
Dispersible tablet
Effervescent tablet

Correct answer: Modified-release tablet

Modified-release (MR) formulations control the rate of drug release to maintain therapeutic levels over a longer period, reducing dosing frequency.

Question 146: What is the STOPP/START tool used for in geriatric pharmacy?

A tool for assessing falls risk
Scoring pain levels in elderly patients
Identifying potentially inappropriate prescribing in older patients and medicines that should be started (Correct answer)
A medication administration system for care homes

Correct answer: Identifying potentially inappropriate prescribing in older patients and medicines that should be started

STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) help identify inappropriate medicines in the elderly and treatments that should be initiated.

Question 147: A prescriber telephones a pharmacy to request an emergency supply of a Prescription Only Medicine. Under what condition can the pharmacist legally make this supply?

Only if the prescriber provides a verbal prescription for any medicine
Emergency supplies from prescriber requests are not permitted under UK law
The prescriber must undertake to furnish a prescription within 72 hours, and the drug must not be a Schedule 1, 2, or 3 controlled drug (Correct answer)
The pharmacist can supply any medicine on a doctor's verbal request without restrictions

Correct answer: The prescriber must undertake to furnish a prescription within 72 hours, and the drug must not be a Schedule 1, 2, or 3 controlled drug

Under the Human Medicines Regulations 2012, a pharmacist can make an emergency supply at the request of a prescriber provided the prescriber undertakes to furnish a prescription within 72 hours. Schedule 1, 2, and 3 controlled drugs (except phenobarbital for epilepsy) cannot be supplied this way.

Question 148: Which of the following medicines requires therapeutic drug monitoring (TDM) due to its narrow therapeutic index?

Amoxicillin
Lithium (Correct answer)
Metformin
Omeprazole

Correct answer: Lithium

Lithium has a very narrow therapeutic index — the difference between a therapeutic dose and a toxic dose is small. Regular serum lithium monitoring is essential (target range 0.4-1.0 mmol/L for maintenance). Toxicity can cause renal failure, seizures, and cardiac arrhythmias.

Question 149: A patient presents with an NHS prescription written 4 months ago. What should the pharmacist do?

Inform the patient the prescription is no longer valid as NHS prescriptions expire after 6 months, but check if it was issued within that period (Correct answer)
Dispense as normal — NHS prescriptions have no expiry
Refuse to dispense and destroy the prescription
Inform the patient that NHS prescriptions are valid for 6 months from the date on the prescription

Correct answer: Inform the patient the prescription is no longer valid as NHS prescriptions expire after 6 months, but check if it was issued within that period

NHS prescriptions in England are valid for 6 months from the date on the prescription (unless the prescriber has specified an earlier date). A 4-month-old prescription is still within validity. The pharmacist should check the date and dispense if within the 6-month window, applying clinical judgement about whether the treatment is still appropriate.

Question 150: Which of the following is one of the four key principles of medicines optimisation as defined by the Royal Pharmaceutical Society?

Ensure all medicines are reviewed at least every 12 months
Prescribe the fewest medicines possible to manage conditions
Aim to understand and respect the patient's experience of taking medicines (Correct answer)
Prioritise adherence above individual patient preferences

Correct answer: Aim to understand and respect the patient's experience of taking medicines

The RPS four principles include understanding the patient's experience, ensuring medicines are used as intended, applying evidence-based choice, and making medicines optimisation a routine part of practice.

Question 151: Which type of emulsion is most suitable for intravenous administration?

Multiple emulsion
Oil-in-water (O/W) (Correct answer)
Microemulsion
Water-in-oil (W/O)

Correct answer: Oil-in-water (O/W)

O/W emulsions are miscible with blood (which is aqueous-based), making them suitable for IV use. W/O emulsions are not compatible with blood.

Question 152: A prescription asks for coal tar solution 5% in aqueous cream to make 100g. The coal tar solution BP contains coal tar 20% w/w. How much coal tar solution BP is required?

10g
25g (Correct answer)
20g
5g

Correct answer: 25g

The final product needs 5% coal tar solution, i.e., 5g of coal tar solution in 100g. But the coal tar solution BP is 20% w/w coal tar. The prescription asks for 'coal tar solution 5%' — meaning 5g of coal tar solution BP per 100g total. Therefore 25g of coal tar solution BP is needed to provide 5g of actual coal tar (25g × 20% = 5g coal tar).

Question 153: A patient presents with a prescription for diazepam 10 mg tablets, 56 tablets. What consideration applies?

Diazepam is Schedule 4 Part 1 CD — it requires a valid prescription but not a CD register entry or safe custody (Correct answer)
It requires full Schedule 2 CD register entry
It can be dispensed without a prescription in an emergency
It cannot be legally prescribed for more than 14 days

Correct answer: Diazepam is Schedule 4 Part 1 CD — it requires a valid prescription but not a CD register entry or safe custody

Diazepam is Schedule 4 Part 1 (benzodiazepines). It requires a valid prescription but not a CD register entry, CD requisition, or mandatory safe custody, though safe storage is recommended.

Question 154: A patient requires anticoagulation but has heparin-induced thrombocytopenia (HIT). Which anticoagulant is appropriate?

Argatroban or fondaparinux (Correct answer)
Low molecular weight heparin
Warfarin alone acutely
Unfractionated heparin

Correct answer: Argatroban or fondaparinux

In HIT, all heparin products (including LMWH) are contraindicated due to cross-reactivity with anti-platelet factor 4 antibodies. Argatroban (direct thrombin inhibitor) or fondaparinux are used instead.

Question 155: A patient with chronic heart failure is being managed with ramipril and bisoprolol. Despite optimal doses, they remain symptomatic (NYHA class III). According to NICE, which additional medication should be considered?

Furosemide dose increase only
Amlodipine
Spironolactone (or eplerenone) (Correct answer)
Digoxin as first add-on

Correct answer: Spironolactone (or eplerenone)

NICE recommends adding a mineralocorticoid receptor antagonist (MRA) such as spironolactone or eplerenone for patients with heart failure with reduced ejection fraction who remain symptomatic despite optimal ACE inhibitor and beta-blocker therapy. This is established step 3 in the heart failure treatment pathway.

Question 156: A patient presents a prescription for 28 days' supply of tramadol. In which Misuse of Drugs Schedule is tramadol classified?

Schedule 5
Schedule 4
Schedule 3 (Correct answer)
Schedule 2

Correct answer: Schedule 3

Tramadol was reclassified as a Schedule 3 CD in 2014. It requires a CD prescription but does not require a CD register entry. Safe custody is required.

Question 157: Which of the following is an example of a 'clinical governance' activity in community pharmacy?

Only ordering stock efficiently
Setting promotional pricing
Decorating the pharmacy premises
Regular audit of dispensing errors and near misses (Correct answer)

Correct answer: Regular audit of dispensing errors and near misses

Clinical governance encompasses activities that improve quality and safety of patient care: clinical audit, error reporting, CPD, risk assessment, and patient feedback mechanisms.

Question 158: A patient is taking warfarin and reports they have started taking aspirin for joint pain. What is the key concern?

No interaction — both are safe together
Increased bleeding risk due to antiplatelet + anticoagulant combination and aspirin-induced gastric bleeding (Correct answer)
Reduced aspirin efficacy
Reduced warfarin efficacy

Correct answer: Increased bleeding risk due to antiplatelet + anticoagulant combination and aspirin-induced gastric bleeding

Aspirin combined with warfarin significantly increases bleeding risk through two mechanisms: synergistic anticoagulant/antiplatelet effect and aspirin-induced GI erosions. This combination should be avoided unless clinically indicated.

Question 159: A dispensary technician checks a dispensed item. What is the legal limitation of this role?

Technicians can perform all checks independently
Technicians cannot check anything legally
Technicians can only count tablets, not check labels
Accuracy checking by technicians is legally permitted for certain accredited technicians, but the final clinical check must be by a pharmacist (Correct answer)

Correct answer: Accuracy checking by technicians is legally permitted for certain accredited technicians, but the final clinical check must be by a pharmacist

Accredited checking technicians (ACTs) can perform accuracy checks in some settings, but the clinical appropriateness check — ensuring the prescription is medically safe — must be performed by a pharmacist.

Question 160: Which validated tool is commonly used in clinical practice to measure a patient's self-reported adherence to long-term medication regimens?

Morisky Medication Adherence Scale (MMAS) (Correct answer)
PHQ-9 questionnaire
AUDIT-C questionnaire
FRAX score

Correct answer: Morisky Medication Adherence Scale (MMAS)

The Morisky Medication Adherence Scale (MMAS) is a validated self-report questionnaire specifically designed to identify patterns of adherence and barriers to taking medicines.

GPhC Registration Assessment

The GPhC Registration Assessment is the UK national examination for trainee pharmacists seeking registration with the General Pharmaceutical Council. It comprises a calculations paper (Part 1) and a clinical and pharmaceutical knowledge paper (Part 2), covering pharmacy law, clinical therapeutics, dispensing practice, pharmaceutical sciences, and public health.

160

Questions

270 min

Time Limit

70%

To Pass

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Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

pharmacyregulation.org — Eligibility, exam dates, fees, registration deadline, score release, exam information · verified Oct 2026
psni.org.uk — Retake policy · verified Oct 2026
assets.pharmacyregulation.org — Test delivery, exam format, passing score, time limit · verified Oct 2026